13th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 1998

January 24-31, 1998
Marilleva, Trento, Italy

RT-215

Primary prevention of sudden arrhythmic death. What did we achieve? What needs to be done with ICD-therapy?

Helmut Klein, Angelo Auricchio, Christoph J. Geller, Hans-Dieter Esperer, Sven Reek, Wolfgang Hartung.
Division of Cardiology, University Hospital, Otto-von-Guericke Universität, Magdeburg, Germany

Introduction

Until a few years ago antiarrhythmic drugs, electrophysiologically guided surgery, catheter ablation and implantation of the automatic defibrillator were competing approaches for the treatment of life-threatening ventricular tachyarrhythmias¹. Today, however, EP-guided surgery and catheter ablation have lost their role in the prevention of sudden arrhythmic death and the results of drug trials like CAST, SWORD, EMIAT² and CAMIAT have raised doubt whether antiarrhythmic drugs are able to prevent sudden cardiac death (SCD) or reduce overall or cardiac mortality in a patient population prone to life-threatening ventricular tachyarrhythmias. The implantable defibrillator, contrarily, has impressively established its role in the treatment of ventricular tachycardia and ventricular fibrillation^3,4.

Until today there is no other approach than ICD treatment that is able to reduce sudden cardiac death to about 2% within two years after a serious arrhythmic event. The beneficial effect of the ICD for secondary prevention of SCD has been demonstrated in the large AVID trial. There was a 38% reduction in overall mortality at 1 year and a 25% decrease at two and three years respectively in comparison with amiodarone or sotalol. We are awaiting the results of two other major secondary prevention trials, the CASH and CIDS studies which also compare ICD treatment with amiodarone. But even if these two studies will demonstrate no ICD benefit it is highly unlikely that amiodarone will be more favorable than ICD treatment. Today, as well as tomorrow, it will be hard to deny that primary treatment for secondary prevention of SCD is other than ICD implantation and there is hardly justification for further SCD secondary prevention trials.